Dinah, ClinkShrink, & Roy produce Shrink Rap: a blog by Psychiatrists for Psychiatrists, interested bystanders are also welcome. A place to talk; no one has to listen.

Thursday, February 12, 2009

The Silent Psychiatrist

This morning, I woke up and got ready for work. Time to go and I called to the kid to come. Only nothing came out. Nothing. I felt fine, but I'd lost my voice. Completely, barely a whisper emerged.

It was just before 8. Kid announced she felt sick and went back to bed. I fetched the carpool kids (--the issues of what to do about carpoolers when one's own child is sick could be its own entire blog). My first patient was for 9:00 and it seemed like too short notice to cancel. I did croak out cancellation calls to the next couple of patients with the thought that they might have a hard time conducting the session without my input; some people don't come in and just talk spontaneously, they look to me for direction, a little more than I sometime wish and a lot more than my voice could tolerate today.

As shrinks go, I talk a lot. As people go, I talk a whole lot. I think I'm probably in the top ten percent for talkativeness in the general population, though I quiet down when ClinkShrink tries to monopolize the podcast.

So suddenly, I couldn't talk. I figured it would be a good experiment, or at least a good blog post. I listened and I let the sessions flow a little more organically. There were places I'd normally interrupt to ask questions-- I didn't. At the end of the session, I asked how it went. The first patient said it was fine once he realized I felt okay (I felt fine). With that, I called the rest of my patients and left the choice to them-- a couple came, a couple didn't. There was one session I'd wondered about, and I did end up having to do a fair amount of talking/croaking.

I wondered if I would be a better therapist-- I sometimes think I talk TOO much. I don't think it was better. I don't think it was particularly worse, either. I'll be happy when I can just talk again. Camel says to rest my voice, Roy says to gargle with salt water. Off to hot tea with honey now. Thank you for letting me croak here.

Yeah, I enjoyed this post. On days when I'm feeling under the weather, I look at it as therapy shift potential. I tend to be talkative, too, as in, directive and didactive. But it's good to challenge the patient.. who am I kidding? challenge myself ... to allow for more unstructured patient talk time. see where it leads.

I don't think it would bother me if my psychiatrist did not talk for a few sessions. I LIKE the fact that he's a "talking" therapist, but sometimes he talks too much, also. Sometimes he leads too strongly and I can't get out what's really bothering me. Some things I STILL have not told him after all this time. Some space, perhaps a LOT of space and I might finally get all that stuff out.

It's not laryngitis that you have. It is some weird transference thing going on. Your patients wish you didn't talk so much and they have somehow communicated this wish and you picked up on that and now you can't talk. So it is a form of hysteria--kind of.Soon your patients will feel guilty that the wish came true and your voice will return.

I just up and left my husband to make a call at the time i was sposed to be there, I refused to get out of bed.

er, um, no, not asking for treatment, just saying I was kinda the reverse of your title, hee.

Sorta. It struck me as funny.

But everything is striking me oddly, these days.

Oh, and um please forgive me, I'm not exactly myself and my thoughts are MOST definitely disorganized (#1 most hated symptom of this transition!! ugh).

well, much more so than usual, heh.

and yar, I'm reporting to my shrink, just so ya'll know. Not that I need to report that to you as docs, but saying it as potentially concerned friends who happen to know a little something about the subject.

Actually - I have a question about silence... well, sorta about silence.

If you have a hunch about a diagnosis of a patient - but your not sure, do you share this hunch with the patient, or stay quiet about it until you are completely 110% sure? Are you open with your patient about the diagnostic process (particularly in more difficult cases, or situations where things change over time), or do you let your thoughts gather and then when the time is right you share what needs to be shared?

If my therapist talked more I might've stayed with it. I accept I'm not a big talker so this petty staredown look-how-good-a-shrink-I-am bullshit doesn't impress me. If I wanted to pay $300 an hour for uncomfortable silences I'd give myself a wedgie and go destroy library books.

Another thing. For someone already inclined to think going to therapy for what they perceive are minor problems is self-indulgent, a shirnk who sits there and doesn't say much leaves to much to the patient's imagination. You could argue its therapuetic but how do you trust and open up to someone you think is tired of listening to your tired stuff?